Raising the bar

University of Minnesota junior Bao Dang does an incline bench Friday in the University Rec Center. Dang is among the legions of avid weightlifters who use dietary supplements to boost their lifts.

As weightlifters resort to more potent supplements in more extreme "stacks" - or combinations of products - some in the fitness industry are beginning to ask if these dietary supplements really promote health at all.

"When you talk about these high doses, it is alarming," said Patrick Wilson, a registered dietician and graduate student at the University of Minnesota School of Kinesiology. "I think it's ludicrous to think you can take as much as you want and not have any harmful effects."

Yet after research and consideration, some weightlifters, such as University junior Bao Dang, say supplements can be the missing piece of a physiological puzzle that includes vigorous training and attention to nutrition.

In the past decade, American consumers have spent nearly $200 billion on supplements, and the industry is growing. But for consumers, navigating supplement makers' hype and misdirection can be a Herculean task.

The growing supplement industry is virtually unregulated by the Food and Drug Administration, with supplements hitting shelves without government testing. The only testing the drugs undergo comes from the trailblazing consumers.

"There's so little regulation around it that it's almost the wild west of nutrition, and companies make outrageous claims and get away with it," Wilson said. "And unfortunately, people buy into it."

A lifter's lifestyle

Serious weightlifters invest everything toward their target lifestyle. That means ensuring at least eight hours of sleep a night, scarfing down as much as 4,000 calories or more per day and lifting intensely at least five days a week.

Bao Dang, a squat, powerful weightlifter, found his way to the sport several years ago for a variety of reasons.

Among them were strength for self defense and physical appearance.

"Girls," Dang said, smiling. "I'm just being honest."

Dang's lifting partner, University sophomore Alex Larson, said that after the first time the two lifted together, two days passed before he could raise his arms over his head.

The two motivate each other as they lift to exhaustion, grinding their teeth and fighting for every last rep as they rotate through 90-minute sessions in the gym.

Like many others, Dang migrated toward supplements for a boost to quicken recovery time and increase energy when he tailored his diet and training but wasn't seeing the results he wanted.

Protein, creatine and even a natural growth hormone booster called PowerFULL became occasional parts of Dang's regimen.

Dang said he accepts that he's neither the biggest nor the strongest person in the gym most days, but he has a long-term vision.

"Maybe someday it will be like the tortoise and the hare, and I'll catch up with them," he said. "They're the competition, but I'm really competing against myself."

After DSHEA, the FDA retained its power to test supplements for safety, but it became a reactionary body. Now it investigates suspicious illnesses related to supplement use, but products go on the market without pre-approval for efficacy, content or safety.

Within the massive industry, the FDA has little ability to monitor and remove potentially dangerous products.

When the dietary supplement ephedra was first linked to heart attacks and strokes in users in 1997, the FDA proposed a ban on products containing the herb.

It took the watchdog seven years to take the supplement off the market; all the while it remained on store shelves.

"You could basically make something in your basement and sell it as a supplement if you wanted to," Wilson said.

Though it reduced government oversight, as intended, DSHEA has dramatically increased consumer access to low-cost supplements.

Prior to its passage, supplements were expensive and far less common.

Sales for online supplement manufacturer Bodybuilding.com, a Utah-based online supplement retailer, have ballooned from less than $20 million in 2002 to more than $140 million in 2009.

The Web site's mission: "To help our visitors reach their health, fitness and appearance goals through information, motivation and supplementation."

Side effects unknown

Five-pound tubs of chocolate-flavored whey protein have long been the building blocks of weightlifting, but stacks of multiple pre- and post-workout products are gaining favor.

Other staples are nitric oxide supplements, which are said to increase blood flow within the body. Also popular is creatine, a compound that helps the body synthesize energy-storing ATP molecules. In clinical trials, creatine has been shown to improve performance in high-intensity, short-term exercise.

Other supplements claim to increase natural production of testosterone or growth hormone.

These ingredients are often combined within products, but when hidden behind the "proprietary blend" label, supplement makers aren't required to reveal the amounts of each ingredient in the product.

"That's a red flag for me," said Rasa Troup, a dietician who reviews supplement safety and efficacy for the University track and field and cross country teams. "If that's a secret, then I don't think I am feeling confident to recommend that at all."

Some supplement users, such as University student Steve Swanson, called the practice "deceptive," saying it makes informed comparison-shopping difficult. Supplement makers contend that it's necessary in order to protect hard-researched formulas in a market increasingly diluted with off-brand and bargain products.

For most lay consumers, however, Wilson said forthright labeling would do little to clear the waters.

"Even if they do look at the back, it's hard to say whether they actually know what's going on, and I guess in general, the American public is not good at reading a food label, and that's probably done on purpose by some in the food industry that don't necessarily want people to know what's going on."

Non-labeled ingredients, in addition to ambiguous labeling, can trip up competitive athletes, even in products claiming to be competition-legal.

In many cases, independent research has revealed banned substances, sometimes at significant levels, not listed on the product's label.

For recreational athletes, testing positive for banned substances is a nonissue, but stacks can still pose a danger, she said.

"Many drugs, if you buy the drug, you know the side effects," she said. "But if you buy the supplement, you have no idea what you're experiencing or what you're looking for because we don't know what the side effects of this combination of proprietary blends is."

Extremely high levels of micronutrients such as Vitamin B6, which is found in Universal Animal Pak multivitamins at 180 mg (9,000 percent of the recommended daily value) per serving, could be acutely dangerous.

"Over the course of a lifetime, if you're taking massive amounts of these vitamins, there's nothing to say these won't be harmful," Wilson said. "We don't have the long-term studies to see if they're going to be harmful or not."

Despite this possibility of dangerous side effects or contamination, Wilson said the biggest danger with most supplements is financial, not medical.

"When it comes to supplements," he said, "I think the biggest risk is probably the waste of money."

Fighting an epidemic

Students who do stay active are fighting the odds in a nation that is statistically fatter every decade.

Obesity, defined by the Center for Disease Control as a body mass index exceeding 30, now weighs down one-third of the population, and more than two-thirds is reported to be overweight (a BMI exceeding 25).

In that struggle, some students seek out help on store shelves.

In the 2009 College Student Health Survey Report, nearly nine percent of respondents admitted to using diet pills in an attempt to lose weight.

More than 60 percent of students reported they exercise vigorously at least three times a week or at moderate intensity five times a week, nearly double the national average among adults.

But those who push back against obesity too hard risk going too far the other way.

"We know that a lot more people suffer from eating-related issues and exercise issues than actually have been diagnosed," Troup said.

The combination of overwork and malnutrition, sometimes called exercise bulimia, can lead to osteoporosis, stress fractures and other severe health problems.

"As Americans, we put more emphasis on image than on health," Wilson said.

But for Steve Swanson, who spends roughly $400 per year on a stack that includes a protein supplement, Gaspari SuperPump and SizeOn, pre- and post-workout supplements

respectively, health is part-and-parcel with an exercise regimen that dietary supplements help make possible.

"I like to look today and see that I'm healthier than I was yesterday," he said.

Swanson said he does cardiovascular training and lifts weights, usually for 90 minutes. An occasional cycle of dietary supplements helps make that time worthwhile, he said.

"I don't want to come here and have it be a waste of time."

For now, Swanson is focused on packing on mass and getting stronger, but he said in the future he'll concentrate more on cardiovascular health and less on strength.

Addicted to pumping iron

Researchers and dieticians agree supplementation is ill-advised for athletes who lack proper nutrition and training.

Even individuals with a solid dietary base shouldn't expect to move mountains with even the best supplements.

"In reality, it might make a 5-10 percent difference in the end," Wilson said, "and many people are expecting more return on their investment, I guess, and it typically doesn't happen."

The biggest benefit may be mental, Wilson said, and for those who are looking for a boost, even an effective placebo can push them closer to their goals.

Alex Larson said if he trained for months with proper nutrition and saw no gains, he would consider adding supplements to his diet to gain an edge.

"If I wasn't seeing any results, I would be concerned. I would be very concerned, and I'd consider taking a supplement then," he said. "That would be like spending a year studying for an exam and then failing it."

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